MEDICARE: DR. LIZZETTE COLON-RAMOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	8062	PR

General Provider Information

NPI Number	:	1114922101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIZZETTE COLON-RAMOS M.D.

Provider Business Mailing Address
First Line	:	10917 E AMINOFF DR
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-4489
Country	:	US
Telephone Number	:	217-881-9059
Fax Number	:	217-881-9059

Provider Business Practice Location Address
First Line	:	1901 S 4TH ST, STE 21
Second Line	:	VA EFFINGHAM CBOC
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-4489
Country	:	US
Telephone Number	:	217-347-7600
Fax Number	:	217-342-9733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/24/2014

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